High grade Spondylolisthesis different surgical management.pptx

High Grade Spondylolisthesis different surgical management

1. High grade Spondylolisthesis : Decompression and In-situ Fixation – A Case Report Central Institute of Orthopaedics , VMMC & Safdarjung Hospital , New Delhi Dr. Apurba Chowdhury ( Post Graduate Resident) Dr. Tankeshwar Boruah (Professor) , Dr. BP Sharma ( Professor), Dr. Mohit Gandhi ( Senior Resident ) Delhi Spine Society Bimonthly Meeting 14 th December , 2024

2. Patient Profile and Clinical Presentation 70years old female. Complaints of pain in lower back region for last 1 year following alleged history of hit by cow at home. Radiculopathy to bilateral lower limbs for last 6 months. Neurological claudication for last 6months. ( Claudication distance 150 meters approx.) Patient walking with crouched gait.

3. Power of bilateral lower limb- intact. Sensation – reduced in L5 and S1 dermatomes Peri-anal sensation- intact Bladder and Bowel function – intact. Known hypertensive for last 6-7 months She has bilateral hearing loss

4. Pre-operative Images Pre-operative Xrays

5. Pre-operative MRI I

6. Pre-operative xrays and MRI shows Anterolisthesis of L5 over S1 with secondary spinal canal stenosis

7. DEXA SCAN Pre-operative DEXA Scan shows Patient is osteoporotic.

8. Pre-Operative Planning and Decision Making Patient has mechanical pain. Neurological claudication due to secondary canal stenosis.

9. Treatment Options Decompression and in-situ fixation Decompression and instrumented fusion Posterior lumbar interbody fusion(PLIF)

10. Surgical Procedure Reduction screw inserted in L4 Pedicle screw inserted in S1 Reduction attempted using straight rods- reduction not achieved

11. Laminectomy and Decompression done. Reduction screw inserted in L5. Auto-Fusion noted between L5 and S1 during Disc preparation. In-situ fixation done.

12. Post-Operative Outcome Power of bilateral lower limb- intact Sensation- improved in L5 and S1 dermatomes( intact sensation) Bowel and bladder function- intact

13. Literature Review

14. Conclusion Decompression and in-situ fixation is a viable treatment option for high grade spondylolisthesis, offering significant improvement in symptoms and quality of life.

15. Thank You